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HELP WITH MEDICARE COSTS.

Although Medicare is the “public health insurance option” for people 65 and over and those with disabilities, it is not free. There are premium costs, co-insurance and deductibles associated with the different parts of Medicare including Prescription Part D plans, which can be a hardship for many on fixed incomes. Fortunately, there are programs that help pay these costs for people who qualify and, even better, federal changes have eased some eligibility requirements in 2011 and beyond.

Medicare Part D Low Income Subsidy (LIS) or Extra Help

What is Low-Income Subsidy (LIS) for the Medicare Part D Prescription Plan? Low-Income Subsidy (LIS) offers help from Medicare to reduce prescription drug costs for those who meet the eligibility criteria. This program assists with the costs associated with Medicare’s prescription drug coverage such as the plan premiums, deductibles, co-payments and the infamous donut hole. The Centers for Medicare and Medicaid Services estimate that many people have not applied for the LIS, even though they may be eligible.

Those who qualify for Low-Income Subsidy have:

♦ Lower or no Part D plan premium.

♦ Discounted copayments.

♦ No coverage gap or “donut hole.”

♦ The right to change Part D plans month-to-month

You qualify for the Low-Income Subsidy if you have Medicare and meet one of these conditions:

♦ You have full Medi-Cal coverage.

♦ You are enrolled in the Medicare Savings Program (MSP). See information on Medicare Savings Programs below.

♦ Your income is below 150% of the Federal Poverty Level and you meet the LIS resource guidelines.

♦ If you have Medi-Cal with a Share of Cost (SOC) or monthly deductible, you may still qualify for LIS even if your income is above 150% of the Federal Poverty Level. If you meet your SOC for any one month between January 1 to June 30, you are “deemed” eligible for the LIS program for the rest of the calendar year.

♦ If you meet your SOC for any one month between July 1 to December 31, you are also “deemed” eligible for LIS for the rest of the calendar year plus the following year.

The application process has been simplified in the following ways:

1) In-kind support and maintenance is not counted as income. (This is the financial help that someone may regularly receive from another person to help pay household expenses such as rent, bills, food, and property taxes.)

2) The cash surrender value of life insurance policies is not counted under the assets limit. To qualify for the Low Income Subsidy in 2011, the following income and asset limits apply:

For an individual—$1,354/month in income and $12,640 in assets
For a married couple—$1,821/month in income and $25,260 in assets

The application form is available online at: www.socialsecurity.gov. People can also apply by calling Social Security at 1-800-772-1213,by visiting a local Social Security office, or by calling HICAP at 1-800-434-0222 – HICAP can give you more information and also help you enroll.

What are Medicare Savings Programs (MSP)?

Medicare offers Medicare Savings Programs (MSP) that assist people with low income and reduce their Medicare costs:

♦ Qualified Medicare Beneficiary (QMB)

♦ Specified Low-Income Medicare Beneficiary (SLMB)

♦ Qualifying Individual (QI)

♦ Qualified Disabled & Working Individual (QDWI)

Though these are Federal programs, Medi-Cal administers them. A client may qualify for a Medicare Savings Program, but not qualify for Medi-Cal because the asset limits for MSP are higher than those for Medi-Cal. Beneficiaries who qualify for MSP also automatically qualify for Low-Income Subsidy (LIS) or “extra help” for their Part D prescription costs.

In review:

Qualified Medicare Beneficiary (QMB) – Pays premiums for Medicare Part A (if applicable) and Part B for beneficiaries who meet the income and asset guidelines; Pays deductibles for both Part A and Part B; Pays the coinsurance or copays for Part A and B.

Specified Low-Income Medicare Beneficiary (SLMB) – Pays the Medicare Part B premium for beneficiaries who meet the income and asset guidelines.

Qualifying Individual (QI) – Pays the Medicare Part B premium for beneficiaries who meet the income and asset guidelines.

For more information or to apply for a Medicare Savings Program (MSP), call HICAP at 1-800-434-0222 to schedule a one-on-one appointment.

What is Medi-Cal?

Medi-Cal is California’s Medicaid program, a public health insurance program which provides needed health care services for certain individuals with limited income and assets. Those that may qualify for Medi-Cal include families with minor children, seniors, people with disabilities, children in foster care, pregnant women, and people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is funded by both the federal and state government.

Can I have both Medicare and Medi-Cal?

It is possible to qualify for both Medicare and Medi-Cal. People who are eligible for both programs are known as “Medi-Medi” or “Dual Eligible” beneficiaries. If you obtain hospital or medical services from providers who accept both Medicare and Medi-Cal, Medi-Cal will help pay the deductibles, coinsurance, and copayments that Medicare does not cover.

What is a Medi-Cal Share of Cost (SOC)?

Some people qualify for Medi-Cal with a Share of Cost (SOC) depending on their income and circumstances. A SOC is like a monthly deductible that must be met before Medi-Cal will pay for any covered medical expenses. Dual-Eligible beneficiaries who have a SOC are also subject to out-of-pocket expenses.

Example:

A beneficiary with Medicare and Medi-Cal has a SOC of $600.00. Her out-of-pocket medical expenses for the month would have to exceed $600 before Medi-Cal will pay.

In the month of June, the only medical service this beneficiary received was one doctor visit that cost $50. Medicare paid only $30 and she was responsible for the remaining $20. She had to pay the $20 because her expense was below the $600 SOC. In the month of July, this beneficiary was hospitalized for one day that cost her $1000 after Medicare paid their portion. The beneficiary pays the monthly $600 Share of Cost and Medi-Cal covers the rest.

In the month of July, this beneficiary was hospitalized for one day that cost $1000. The beneficiary pays the monthly, $600 Share of Cost and Medi-Cal pays the rest.

For more information, call HICAP at 1-800-434-0222 to schedule an appointment.

I have Medicare and Medi-Cal. What covers my prescription medications?

People with Medicare and Medi-Cal who are sometimes known as “Medi-Medi” or “Dual Eligible” beneficiaries receive drug coverage under Medicare Part D. Beneficiaries with full Medi-Cal, i.e. without a Share of Cost, automatically qualify for Low-Income Subsidy (LIS), the “Extra Help” for Medicare Part D costs. Beneficiaries with a Medi-Cal Share of Cost may also be eligible for Low-Income Subsidy.

For more information, call HICAP at 1-800-434-0222 to schedule an appointment.

Butte CountyTo file for social security benefits in Butte County, contact the Oroville Social Security Administration office at the address below or call the Social Security Administration’s national toll-free number at 1-800-772-1213.

115 Table Mountain Boulevard
Oroville, CA 95965-3503
(866) 331-7130

Other office:
2035 Forest Ave
Chico, CA 95928
(866) 964-7585

Plumas CountyTo file for social security benefits in Plumas and surrounding Counties, contact the Susanville Social Security Administration office at the address below or call the Social Security Administration’s national toll-free number at 1-800-772-1213.

2603 Riverside Drive
Susanville, CA
(530) 257-2032

Tehama CountyFor information about social security benefits and other issues in Tehama County, contact one of the following county centers in Redding (Shasta) or Chico (Butte)

2660 Park Marina Dr # A,
Redding, CA 96001
(866) 964-1236

Other office:
2035 Forest Avenue,
Chico, CA 95928
(866) 964-7585

Glenn CountyFor information about Social Security benefits and other issues in Glenn County, contact the Chico office in Butte County:

2035 Forest Avenue
Chico, CA 95928
(866) 964-7585

Colusa CountyFor more information about Social Security benefits in Colusa County, contact one of the following county centers in Yuba City (Sutter), Oroville (Butte), or Chico (Butte):